Le Mithetho, iqale ukusebenza ngomhla woku-1 kuJanuwari ka-1998 kwaye yagqityezelwa ukulungiswa ukususela ngomhla we-11 kuMatshi ka-2022 ilawula ubudlelwane phakathi kwe-Ombudsman ye-Inshurensi yexesha elide kunye nelungu ngalinye leShishini le-Inshurensi yexesha elide elirhuma kwiskimu sikaNozikhalazo njengoko naphakathi koNozikhalazo kunye nommangali ngamnye ofaka isikhalazo kwi-ofisi yeOmbudsman.
1. Imishini
1.1 Imishini ye-Ombudsman yeyokwamkela nokuqonda izikhalzgo ngokubhekiselele kumalungu arhumayo nokusombulula izikhalazo ngokungenelela ,uxolelwano,ukucebisa nokumisa.
1.2 I-Ombudsman iza kufuna ukuqinisekisa ukuba:
1.2.1 usebenza ngokuzimeleyo ngenjongo zokusombulula nasiphina isikhalazo ezifikileyo ingathi miyalelo nakubani na ngokubhekiselele ngokusebenzisa igunya lakhe;
1.2.2 ulandela inkqubo esulungekileyo nevumelekileyo enefuthe elililo;
1.2.3 ugcina ukulingana phakathi kwabakhalazi kunye namalungu arhumayo;
1.2.4 usebenza ngokobunzima ukuqwalaselo ulingano;
1.2.5 uyigcina iyimfihlelo njengoko icacisiwe ku mthetho- 7 apha ngezantsi, ngokubhekiselele kwizikhalazo ezifikileyo;
1.2.6. usebenzisana neBhunga elisekwe ngokoMthetho woLawulo lweCandelo lezeMali, (uMthetho we-9 ka-2017), ekukhuthazeni ulwazi loluntu ngobukho, ukusebenza kunye nokusebenza kukaNozikhalazo kunye ne-Ofisi kaNozikhalazo kunye nokwazisa abathengi kunye nezinto ezinokubakho. abamangali kwiiforam ezikhoyo zokusombulula iingxabano;
1.2.7. Amalungu arhumayo asebenza ngokufanelekileyo nangokuthathela ingqalelo kokubini incwadi nomoya wesivumelwano phakathi kwamaqela kunye nokubonelela ngenkonzo eyiyo kwabo benza isivumelwano nabo.
2. Ulawulo lwezobulungisa
2.1 Ngoko mthetho 2.2 no 2.3 ngezantsi,i-Ombudsman iyakwamkela iqwalasele isikhalazo ngasinye ngomnini polisi, umlandeli ngokwetayitile okanye indlalifa,ngokuchasene nelungu elirhumayo ngokwe marike,isiphelo,ukutolikwa nokufakwa nokupheliswa kwesivumelwano se-inshorensi yexesha elide ethengisiweyo okanye esebenza ngaphakathi kuMzantsi Afrika.
2.2 Ombudsman ayikuqwalasela isikhalazo:
2.2.1 ukuba iyi okanye ibikhe besingumcimbi wenkqubo yomthetho yaze ayarhoxiswa okanye inkqubo yomthetho icinga ukuba ifakwe ngumkhalazi ngexesha isikhalazo sisajongwa yi-Ombudsman; okanye
2.2.2 Ukuba ngaphambili yayikhe yamiswa yi-Ombudsman ,ngaphandle kokuba ubungqina obutsha bungathi bube nefuthe kwiziphumo zomiso lwangaphambili buthi emva koko bubekho okanye;
2.2.3 Ukuba iminyaka emithathu okanye ngaphezulu idlulile ukusuka kumhla esabekwa ngawo isikhalazo okanye ukuba kukho izizathu ezikhoyo ezibonisa indoda okanye umfazi wenza isikhalazo kwi-Ombudsman , ngaphandle kokuba ukungaphumeleli ukukhalaza ngexesha elimisiweyo kungenxa yemeko apho ngokoluvo lwe-Ombudsman umkhalazi akanakubekwa tyala.
2.3 Umkhalazi makangajongi:
2.3.1 okubhalwe phantsi kwepolisi okanye;
2.3.2 Eyona migangatho, itables,imithetho–siseko esithi amalungu arhumayo ibe kwi-inshorensi yamashishini exesha elide,kuqukiwe ngaphandle kuthintelwe kwi;
2.3.2.1 indlela yokubala ivelise ixabiso yaza yahlawula lonke ixabiso lepolisi ebuzwayo okanye;
2.3.2.2 Kwimeko apho kwingeniso okanye ibonasi yepolisi igudisiwe, i-system yebonasi nebonasi rate zikho kule polisi ibuzwayo; okanye
2.3.3 kwimeko yezivumelwano ezidibeneyo ukusebenza kwepotifoiyo apho izivumelwano zidibeneyo.
Ukuba i-Ombudsman ingafikelwa iqwalasele isikhalazo esinje ukuba indoda okanye umfazi unoluvo lokuba inzuzo yemali iyongezeleka kumnini polisi okhalazayo ngokoku kungentla ingathi iphakamise iprima facie inference yokuphindwa okanye ukungakhathali kwicala lelungu elirhumayo okanye impahla ayibonwanga ngendlela eyiyo ngokubhekiselele kwimiba engafakwanga apha ngentla.
3. Inkqubo
3.1 I-Ombudsman iyakwamkela ileta ebhaliweyo yezikhalazo ,echaza ulwazi olungaphezulu okanye icebiso elililo elakubonwa njengelibalulekileyo elifuna ukusombulula ingxaki zonke zomkhalazi ngokulawula,uxolelwano ngecebo okanye ngokulawula.
3.2 Kungalawula mhlawumbi ngoku:
3.2.1 ukuhla okanye ukuqwalasela umkhalazi;
3.2.2 ukubamba umkhalazi wonke okanye icala;
3.2.3 ukugxotha umkhalazi;
3.2.4 ukwenza imithetho yenkqubo okanye indlela yobungqina;
3.2.5 umvuzo wobuyekezo ngaphandle kokumiselwa okwenziwe kumthetho 3.2.2 or 3.2.3 yempahla engeyiyo okanye ukuhlupha okanye ukuphulukana nemali esokolwe ngumkhalazi ngenxa yempazamo, ukushiywa okanye ukungabhalwa kakuhle(kuquka ukungamkeleki okanye ukungalungeli inkonzo ngakwicala lelungu elirhumayo, ngaphandle kokuba ixabiso lembuyekezo alisayikudlula isixa esinga R15 000 okanye ezinye izixa ezinjenge-Long- term Insurance Ombudsman’s Council (“the Council”) amaxesha ngamxesha angamiselwa;
3.2.6 ilungu elirhumayo kunye namanye amacebo okanye ukumiswa okwenziweyo,ukubhatala inzala kumkhalazi kwisixana ngokobungakanani ukususela kumhla ekubonwa ukuba usulungekile olinganayo ngokwemeko.
3.3 I-Ombudsman ingagxotha ngaphandle kokumbona njengelunga elirhumayo, ukuba kwindoda okanye umfazi kubonakala kuye ulwazi lomkhalazi, ukuba:
3.3.1 umkhalazi akanasizathu sokubona impumelelo okanye;
3.3.2 umkhalazi ulandela imfeketho ,ecaphukisayo okanye indlela yokuxhaphaza okanye;
3.3.3 Umkhalazi akakasokoli kwaye akubonakali ngathi angasokola ngempahla engeyiyo okanye ukuhlupha okanye ukuphulukana nemali ngokwentsingiselo yomthetho 3.2.5
3.4 Ukuba ngaba umkhalazi okanye ilungu elirhumayo aliphumelelanga okanye lala ukunikeza ngolwazi oluceliweyo y-Ombudsman ngokwexesha elibekelwe ezonjongo,i-Ombudsmans iyakukhululeka ukufumana ulwazi kangangoku njengoko kungathi kanti lukho kuye.
3.5 Ulawulo elwenziwe yi-Ombudsman luyakuliqamangela ilungu elo lirhumayo.
3.6 Ulawulo olwenziwe yi –Ombudsman alukuveliswa kumkhalazi kengoko kuyakufakwa inkqubo yomthetho ngaphandle kokujonga ezinye izikhalazo ezikwanjalo.
3.7 Zonke izinto ezinikelwanayo phakathi kwe-ofisi ye-Ombudsman nomkhalazi ,kwelinye icala i-ofisi kunye nelungu elirhumayo ngokubhekiselele kwisikhalazo eso konke okubhaliweyo okubhalwe ngalo mba , ngokwesivumelwano kuyakubonwa njengelungelo elilodwa kwaye liyakhusela ekuvelisweni kobungqina, obugcinwe ngokomyalelo wenkundla okanye ngokwamaqela amabini aqwalaselwayo.
4. Ummiselo
Ukwamkelwa komkhalazi yi-Ombudsman kumisa konke okunye ukubopheleleka okukhoyo ngelo xesha ngokomthetho okanye ummmiselo we-Act( Act 68 of 1969) -ngokwelixesha de abe isikhalazo siyekisiwe ngumkhalazi lowo, kuyakulawulwa yi-Ombudsman okanye naluphina ubheno ngokubhekiselele kule mithetho igqityiwe ngoku.
5. Ulwazi malunga neOmbudsman
Amalungu arhumayo aya kuchaza ukufumaneka kunye neenkcukacha zoqhagamshelwano zikaNozikhalazo ku:
5.1 abanini-polisi kwindawo yokuthengisa nakunxibelelwano lwamaxesha ngamaxesha;
5.2 abenzi-mabango xa ibango laliwe;
5.3 abamangali xa isikhalazo singasonjululwanga ngakwicala labamangali;
5.4 amalungu oluntu kwiwebhusayithi yayo nakwizakhiwo zayo;
5.5 Kolu mamelo yonke imiba yenkqubo okanye enjengobungqina buyakulawulwa yi-Ombudsman okanye umntu okanye umntu owonyuliweyo.
6. Inkxaso-mali
Amalungu arhumayo aya kuhlawula iirhafu kunye neentlawulo zetyala ezibizwayo zeOmbudsman, kuNozikhalazo, xa kuyimfuneko.
6.1 Umkhalazi okanye ilungu elirhumayo eliziva lidlelwa indlala lolu lawulo lwe-Ombudsman angenza isicelo kwi-Ombudsman sekhefu ukuze akwazi ukubhenele isigqibo sayo kwenziwe i-Appeal Tribunal.
6.2 Eso sicelo kufuneka senziwe kwixesha elingangenyanga enye ukususela kumhla ulawulo olwenziwa ngalo.
6.3 Elo khefu liyakunikwa xa:
6.3.1 Ukuba ulawulo lolwelungu elirhumayo kwaye bakufuna imali engaphezulu kweR250 000 okanye isixa esi sesinye njengoko ikhansile isoloko ilawulo ngamaxesha ngamxesha;
6.3.2 Ukuba i-Ombudsman inoluvo lokuba ukulawula kulo mba kuvuselela umdla woluntu kunye nakushishino okanye;
6.3.3 Ukuba i-Ombudsman inoluvo lokuba umkhalazi uhlungisiwe okanye ilungu elirhumayo linesizathu esisiso esinokulenza liphumelele kwisibheno phambili kokuba kubekho i-Appeal Tribunal.
6.4 Ilungu okanye amalungu e-Appeal Tribunal luyakonyulwa yi-Ombudsman ngemvume yamaqela onke achaphazelekayo okanye kungenjalo ngemvume ka-Chairman wekhansile okanye ,ukuba lo ndoda okanye umfazi akakho, amalungu amabini ekhansile angahlananga neshishini.
6.5 Ombudsman iyakulingisa ingxelo ezakuqwalaselwa yi-Appeal Tribunal.
6.6 Yonke imiba yenkqubo okanye ubungqina buyakulawulwa yiAppeal Tribunal ngokwayo.
6.7 Isigqibo se-Appeal Tribunal asinakuphikiswa kwaye siyakuqamangela:
6.7.1 Ukuba umkhalazi ngumbheni kuwo onke amaqela aqwalaselwayo;
6.7.2 Ukuba ilungu elirhumayo lingumbheni kuyo.
6.8 Xa umkhalazi engumbheni:
6.8.1 Indoda okanye umfazi kungafuneka adipozithe eso sixa semali njengoko i-Ombudsman iyakuqwaslaela ngobunono kwi –akhawunti yetrust yegqwetha elonyulwe yi-Omnbudsman;
6.8.2 eso sixa siyakugcina kwitrust de kuphume izinye zesibheno;
6.8.3 Ukuba isibheno ngokubona kwe-Appeal Tribunal siphumelele gqibelele ,eso sixa siyakubuyiselwa kwakhona kumkhalazi;
6.8.4 Ukuba isibheno ngokubona kwe-Appeal Tribunal asiphumelelanga gqibelele;eso sixa siyakuthathwa yi-Ombudsman njengentlawulo yonke okanye isixana, njengendleko zeenkqubo zokubhena ze eseleyo ibuyiselwe kumkhalazi.
6.9 Xa umkhalazi elilungu elirhumayo:
6.9.1 Isibheno ngokubona kwe-Appeal Tribunal siphumelele gqibelele,iindleko zeenkqubo yobheno ziyakuba zeze-Ombudsman;
6.9.2 Isibheno ngokubona kwe-Appeal Tribunal asiphumelelanga gqibelele,ilungu elirhumayo liyakuhlawula zonke iindleko zenkqubo yesibheno.
7. Ingxelo
I-Ombudsman iya kwenza ingxelo esidlangalaleni ngomhla okanye phambi kwe-31 kaMeyi kunyaka ngamnye ngemisebenzi yakhe kwikhalenda yangaphambili.
7.1 Ukuba ilungu elirhumayo aliphumelelanga okanye lalile ukuthobela ukulawulwa okwenziwe yi-Ombudsman:
7.1.1 Liyakunikwa isaziso yi-Ombudsman sokuba liyithobele kulo lawulo ngexesha elingangeveki ezine okanye ixesha elide kunoko njengoko i-Ombdusman ingalixela;
7.1.2 Ukungaphumeleli okanye ukwala ukuthobela esi saziso kwelungu elirhumayo,i-Ombudsman iyakunikeza ngengxelo yokungaphumeleli okanye ukwala ku-Chairman we-Long term Insurance Ombudsman’s Committee (“the Committee”).
7.2 I-Ombudsman inga:
7.2.1 ingalawula ntoni, ukuba kungakho amanye amathuba anganqandwa kwilungu elirhumayo elichaphazelekayo lokwenza ukubonisa ukuba kutheni le milinganiselo ingezantsi ingenakusetyenziswa;
7.2.2 ukupapasha, nangeyiphina indlela ebonisa ukuba i-Ombudsman yenze kakuhle, ubunyani bokungaphumeleli okanye bokwala;
7.2.3 ukimiswa okanye ukupheliswa kwembobo zika-Chairman wekhansile kunye nekomiti,ilungu elihlawulayo elichaphazeleka kulo meko;
7.2.4 ukupapasha nangeyiphina indlela ebonisa ukuba i-Ombudsman yenze kakuhle,ubunyani bokukumiswa okanye ukupheliswa kobulungu.
8. Ulwazi malunga neOmbudsman
Amalungu arhumayo aya kuchaza ukufumaneka kunye neenkcukacha zoqhagamshelwano zikaNozikhalazo ku:
8.1 abanini-polisi kwindawo yokuthengisa nakunxibelelwano lwamaxesha ngamaxesha;
8.2 abenzi-mabango xa ibango laliwe;
8.3 abamangali xa isikhalazo singasonjululwanga ngakwicala labamangali;
8.4 amalungu oluntu kwiwebhusayithi yayo nakwizakhiwo zayo.
9. Inkxaso-mali
Amalungu arhumayo aya kuhlawula iirhafu kunye neentlawulo zetyala ezibizwayo zeOmbudsman, kuNozikhalazo, xa kuyimfuneko.
